Walsh B Timothy, Fairburn Christopher G, Mickley Diane, Sysko Robyn, Parides Michael K
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
Am J Psychiatry. 2004 Mar;161(3):556-61. doi: 10.1176/appi.ajp.161.3.556.
The authors' goal was to determine whether treatments known to be effective for bulimia nervosa in specialized treatment centers can be used successfully in primary health care settings. They examined the benefits of two treatments for bulimia: 1) fluoxetine, an antidepressant medication, and 2) guided self-help, an adaptation of cognitive behavior therapy.
Ninety-one female patients in two primary care settings were randomly assigned to receive fluoxetine alone, placebo alone, fluoxetine plus guided self-help, or placebo and guided self-help.
The majority of the patients did not complete the treatment trial; many patients found the treatment program too demanding, but others indicated it was not sufficiently intensive. Patients assigned to fluoxetine attended more physician visits, exhibited a greater reduction in binge eating and vomiting, and had a greater improvement in psychological symptoms than those assigned to placebo. There was no evidence of benefit from guided self-help.
The treatment of patients with bulimia nervosa in a primary care setting is hampered by a high dropout rate. Guided self-help, a psychological treatment based on cognitive behavior therapy, appears ineffective, but treatment with fluoxetine is associated with better retention and substantial symptomatic improvement.
作者的目标是确定在专业治疗中心已知对神经性贪食症有效的治疗方法是否能在初级卫生保健机构成功应用。他们研究了两种治疗神经性贪食症的方法的益处：1）氟西汀，一种抗抑郁药物，以及2）引导式自助，一种认知行为疗法的改编形式。
在两个初级保健机构的91名女性患者被随机分配接受单独的氟西汀、单独的安慰剂、氟西汀加引导式自助，或安慰剂和引导式自助。
大多数患者没有完成治疗试验；许多患者觉得治疗方案要求过高，但其他患者表示强度不够。与分配到安慰剂组的患者相比，分配到氟西汀组的患者就诊次数更多，暴饮暴食和呕吐症状减轻得更多，心理症状改善得也更多。没有证据表明引导式自助有好处。
初级卫生保健机构中神经性贪食症患者的治疗受到高辍学率的阻碍。基于认知行为疗法的心理治疗引导式自助似乎无效，但氟西汀治疗与更好的治疗依从性和显著的症状改善相关。
